Parkinson’s disease is a chronic and progressive disorder that involves malfunction and death of nerve cells in the brain. Some of these neurons produce dopamine, a chemical that sends messages to the parts of the brain that control movement and coordination. When neurons die or are damaged, dopamine in the brain decreases, and the person is less and less able to control movement.
To diagnose Parkinson’s disease, a doctor will perform a neurological examination and take a careful history. There are no standard diagnostic tests for Parkinson’s, although certain imaging technology may be helpful. Mild cases may be difficult to confirm since many neurological conditions have a similar appearance to Parkinson’s.
The cause or causes of Parkinson’s disease are unknown. Many experts think that it is caused by a combination of genetic and environmental factors, which are different from person to person. Aging is an important risk factor. There is a 2-4% risk for Parkinson’s among people over age 60, which is about twice the rate in the general population.
Each person experiences Parkinson’s disease differently. Some experience tremor as the main problem, while others might experience falls, slow movements, and rigidity in their muscles. Doctors cannot accurately predict how Parkinson’s will affect a certain person. Instead, they will usually focus on reducing a person’s symptoms, improving the patient’s quality of life, and preventing complications.
Parkinson’s diagnosis does not come from a test, but instead requires a careful medical history and a physical examination. Signs of the disease include resting tremor, bradykinesia (slow movement), rigidity (stiffness and/or inflexibility of the limbs, trunk, and neck), and unstable posture. Other motor signs might include freezing/shuffling gait, unwanted accelerated movements, speech difficulty, stooped posture, restless movements, difficulty swallowing, and others.
The good news is, there have been major advances in how we understand Parkinson’s disease. A better understanding of how neurons die gives us information on how to actually stop this disease. A lot of work remains to be done, but our understanding of the disease is improving every day.
While medication is a mainstay of treatment, other things can also help. Exercise, physical therapy, speech therapy, and occupational therapy are commonly used to help patients maintain normal daily activities. Staying engaged in your care is important to help stay active and prevent cognitive decline. Other alternative therapies can be beneficial, such as acupuncture, which may help reduce tremor, and massage therapy, which may help with muscle spasms.
It is important to seek help as soon as you feel less able to cope with Parkinson’s disease. By taking action early, you will be better able to handle the effects of Parkinson’s. Other steps you can take include finding out as much as you can about Parkinson’s; talking to friends and family about it; learning to manage stress; continuing to do things you enjoy; and not hesitating to ask your doctor, nurse, or other provider for help.
ON time refers to the period where medications control your Parkinson’s symptoms. Once the medication stops working, your symptoms can reappear, which is known as an OFF episode. During an OFF episode, you may experience tremors, stiff and slow movement, difficulty balancing, or any other symptoms of PD. OFF episodes occur for a variety of reasons, including your medication wearing off, changes in the way you absorb the medication, or long periods without medication, like when you are sleeping.
The number of OFF episodes usually increases over time. There are several ways to minimize OFF episodes, including taking a higher dose of levodopa, decreasing the amount of time between doses, or adding another medication.
There are also “on-demand” medications that can bring you back to an “ON” state quickly after an OFF episode begins. Levodopa can be administered via an inhaler or directly into the stomach through a small tube.
Apomorphine is a medication that mimics dopamine and can rapidly reduce symptoms during OFF episodes. Apomorphine can be taken sublingually as a film that dissolves under the tongue or subcutaneously as an injection under the skin.
Resources and Additional Reading:
Davis Phinney Foundation for Parkinson’s. The 17 Most Commonly Asked Questions about Parkinson’s Nutrition. Available at: https://www.davisphinneyfoundation.org/blog/the-17-most-commonly-asked-questions-about-parkinsons-nutrition/
Parkinson’s Foundation. Frequently Asked Questions: A Guide to Parkinson’s Disease. Available at: https://www.parkinson.org/sites/default/files/attachments/Parkinsons-Disease-Frequently-Asked-Questions.pdf
Rush University. Parkinson’s Disease: FAQ. Available at: https://www.rush.edu/services-treatments/parkinsons-disease/parkinsons-disease-faqs
WebMD. Frequently Asked Questions About Parkinson’s Disease. Available at: https://www.webmd.com/parkinsons-disease/guide/parkinsons-faq#2